Provider Demographics
NPI:1619170628
Name:UNITED DISCOUNT DRUG
Entity Type:Organization
Organization Name:UNITED DISCOUNT DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:TERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-477-0800
Mailing Address - Street 1:600 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-5513
Mailing Address - Country:US
Mailing Address - Phone:580-477-0800
Mailing Address - Fax:580-477-0802
Practice Address - Street 1:600 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-5513
Practice Address - Country:US
Practice Address - Phone:580-477-0800
Practice Address - Fax:580-477-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0833880001Medicare NSC